Pediatric Radiology

, Volume 42, Issue 9, pp 1070–1079 | Cite as

Color Doppler US of normal cerebral venous sinuses in neonates: a comparison with MR venography

  • Elka MillerEmail author
  • Alan Daneman
  • Andrea S. Doria
  • Susan Blaser
  • Jeffrey Traubici
  • Jose Jarrin
  • Rahim Moineddin
  • Aideen Moore
  • Manohar Shroff
Original Article



Color Doppler US (CDUS) has been used for evaluation of cerebral venous sinuses in neonates. However, there is very limited information available regarding the appearance of superficial and deep normal cerebral venous sinuses using CDUS and the specificity of the technique to rule out disease.


To determine the specificity, inter-modality and inter-reader agreement of color Doppler US (CDUS). To evaluate normal cerebral venous sinuses in neonates in comparison to MR venography (MRV).

Materials and methods

Newborns undergoing a clinically indicated brain MRI were prospectively evaluated. All underwent a dedicated CDUS of the cerebral venous sinuses within 10 h (mean, 3.5 h, range, and 2–7.6 h) of the MRI study using a standard protocol.


Fifty consecutive neonates participated in the study (30 males [60%]; 25–41 weeks old; mean, 37 weeks). The mean time interval between the date of birth and the CDUS study was 19.1 days. No cases showed evidence of thrombosis. Overall agreement for US reading was 97% (range, 82–100%), for MRV reading, 99% (range, 96–100%) and for intermodality, 100% (range, 96–100%). Excellent US-MRI agreement was noted for superior sagittal sinus, cerebral veins, straight sinus, torcular Herophili, sigmoid sinus, superior jugular veins (94–98%) and transverse sinuses (82–86%). In 10 cases (20%), MRV showed flow gaps whereas normal flow was demonstrated with US. Visualization of the inferior sagittal sinus was limited with both imaging techniques.


Excellent reading agreement was noted for US, MRV and intermodality. CDUS is highly specific to rule out cerebral venous thrombosis in neonates and holds potential for clinical application as part of clinical-laboratory-imaging algorithms of pre/post-test probabilities of disease.


Color Doppler US Cerebral venous sinuses MRI MR venography Neonates 



We thank the Physicians Services Incorporated Foundation (PSI) and the Sick Kids Trainee’s Start Up Fund, Toronto, Canada, for financial support. Dr. Andrea S. Doria is supported by the Salary Award from the Canadian Child Health Clinicians Scientist Program. We thank Wendy Doda for administrative support. We are grateful to the families who consented to take part in the study, and to the nursing and medical staff members of the Hospital of Sick Children, Toronto, who participated in caring for the infants.


  1. 1.
    Taylor GA, Walker LK (1992) Intracranial venous system in newborns treated with extracorporeal membrane oxygenation: Doppler US evaluation after ligation of the right jugular vein. Radiology 183:453–456PubMedGoogle Scholar
  2. 2.
    Wong WS, Tsuruda JS, Liberman RL et al (1989) Color Doppler imaging of intracranial vessels in the neonate. AJR 152:1065–1070PubMedGoogle Scholar
  3. 3.
    Couture A, Veyrac C, Baud C et al (2001) Advanced cranial ultrasound: transfontanellar Doppler imaging in neonates. Eur Radiol 11:2399–2410PubMedCrossRefGoogle Scholar
  4. 4.
    Lowe LH, Bailey Z (2011) State-of-the-art cranial sonography: Part 1, modern techniques and image interpretation. AJR 196:1028–1033PubMedCrossRefGoogle Scholar
  5. 5.
    Epelman M, Daneman A, Kellenberger CJ et al (2010) Neonatal encephalopathy: a prospective comparison of head US and MRI. Pediatr Radiol 40:1640–1650PubMedCrossRefGoogle Scholar
  6. 6.
    Stolz EP (2008) Role of ultrasound in diagnosis and management of cerebral vein and sinus thrombosis. Front Neurol Neurosci 23:112–121PubMedGoogle Scholar
  7. 7.
    deVeber G, Andrew M, Adams C et al (2001) Cerebral sinovenous thrombosis in children. N Engl J Med 345:417–423PubMedCrossRefGoogle Scholar
  8. 8.
    Ramenghi LA, Govaert P, Fumagalli M et al (2009) Neonatal cerebral sinovenous thrombosis. Semin Fetal Neonatal Med 14:278–283PubMedCrossRefGoogle Scholar
  9. 9.
    Grossman R, Novak G, Patel M et al (1993) MRI in neonatal dural sinus thrombosis. Pediatr Neurol 9:235–238PubMedCrossRefGoogle Scholar
  10. 10.
    Zimmerman RA, Bilaniuk LT, Hackney DB et al (1986) Magnetic resonance imaging of dural venous sinus invasion, occlusion and thrombosis. Acta Radiol Suppl 369:110–112PubMedGoogle Scholar
  11. 11.
    Agid R, Shelef I, Scott JN et al (2008) Imaging of the intracranial venous system. Neurologist 14:12–22PubMedCrossRefGoogle Scholar
  12. 12.
    Fletcher RH, Fletcher SW (2005) Clinical epidemiology: the essentials. Williams & Wilkins, PhiladelphiaGoogle Scholar
  13. 13.
    Shroff M, deVeber G (2003) Sinovenous thrombosis in children. Neuroimag Clin N Am 13:115–138CrossRefGoogle Scholar
  14. 14.
    Teksam M, Moharir M, Deveber G et al (2008) Frequency and topographic distribution of brain lesions in pediatric cerebral venous thrombosis. AJNR 29:1961–1965PubMedCrossRefGoogle Scholar
  15. 15.
    Kersbergen KJ, Groenendaal F, Benders MJ et al (2011) Neonatal cerebral sinovenous thrombosis: neuroimaging and long-term follow-up. J Child Neurol 26:1111–1120PubMedCrossRefGoogle Scholar
  16. 16.
    Dlamini N, Billinghurst L, Kirkham FJ (2010) Cerebral venous sinus (sinovenous) thrombosis in children. Neurosurg Clin N Am 21:511–527PubMedCrossRefGoogle Scholar
  17. 17.
    Bezinque SL, Slovis TL, Touchette AS et al (1995) Characterization of superior sagittal sinus blood flow velocity using color flow Doppler in neonates and infants. Pediatr Radiol 25:175–179PubMedCrossRefGoogle Scholar
  18. 18.
    Widjaja E, Griffiths PD (2004) Intracranial MR venography in children: normal anatomy and variations. AJNR 25:1557–1562PubMedGoogle Scholar
  19. 19.
    Huysmans MC, Longbottom C (2004) The challenges of validating diagnostic methods and selecting appropriate gold standards. J Dent Res 83 Spec No C:C48-52Google Scholar
  20. 20.
    Garrett ES, Eaton WW, Zeger S (2002) Methods for evaluating the performance of diagnostic tests in the absence of a gold standard: a latent class model approach. Stat Med 21:1289–1307PubMedCrossRefGoogle Scholar
  21. 21.
    Connor SE, Jarosz JM (2002) Magnetic resonance imaging of cerebral venous sinus thrombosis. Clin Radiol 57:449–461PubMedCrossRefGoogle Scholar
  22. 22.
    Eichler F, Krishnamoorthy K, Grant PE (2007) Magnetic resonance imaging evaluation of possible neonatal sinovenous thrombosis. Pediatr Neurol 37:317–323PubMedCrossRefGoogle Scholar
  23. 23.
    Rollins N, Ison C, Booth T et al (2005) MR venography in the pediatric patient. AJNR 26:50–55PubMedGoogle Scholar
  24. 24.
    Pui MH (2004) Cerebral MR venography. Clin Imaging 28:85–89PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Elka Miller
    • 1
    • 4
    Email author
  • Alan Daneman
    • 1
  • Andrea S. Doria
    • 1
  • Susan Blaser
    • 1
  • Jeffrey Traubici
    • 1
  • Jose Jarrin
    • 1
  • Rahim Moineddin
    • 3
  • Aideen Moore
    • 2
  • Manohar Shroff
    • 1
  1. 1.Department of Diagnostic ImagingHospital for Sick ChildrenTorontoCanada
  2. 2.Department of NeonatologyHospital for Sick ChildrenTorontoCanada
  3. 3.University of TorontoTorontoCanada
  4. 4.Diagnostic Imaging DepartmentChildren’s Hospital of Eastern Ontario (CHEO)OttawaCanada

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